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pearl
1
Dexamethasone provides effective PONV prophylaxis (NNT 3.7). There is however no benefit of an 8 to 10 mg IV dose over a lower 4 to 5 mg dose.
De GS, Castro-Alves LJ, Ahmad S et al. Dexamethasone to prevent postoperative nausea and vomiting: an updated meta-analysis of randomized controlled trials. Anesth. Analg. 2013 Jan 1;116(1):58-74.
  Daniel Jolley
summary
1
Meta-analysis of 10 RCTs totalling 633 subjects showed that while pain at rest following laparoscopic surgery was reduced by transverse abdominis plane block, early (0-4 h) pain was only moderately reduced (-2.4 cm) and late pain (24 hours) minimally reduced (-1.3 cm). Pain with movement was not significantly different between TAP blocks and controls.
De GS, Castro-Alves LJ, Nader A et al. Transversus abdominis plane block to ameliorate postoperative pain outcomes after laparoscopic surgery: a meta-analysis of randomized controlled trials. Anesth. Analg. 2014 Feb 1;118(2):454-63.
  Daniel Jolley
pearl
1
TAP block reduced early and late pain at rest after laparoscopic surgery, though not pain with movement.
De GS, Castro-Alves LJ, Nader A et al. Transversus abdominis plane block to ameliorate postoperative pain outcomes after laparoscopic surgery: a meta-analysis of randomized controlled trials. Anesth. Analg. 2014 Feb 1;118(2):454-63.
  Daniel Jolley
pearl
1
TAP block reduces pain severity, morphine consumption and opioid side effects after caesarean section when intrathecal morphine is not used.
Abdallah FW, Halpern SH, Margarido CB. Transversus abdominis plane block for postoperative analgesia after Caesarean delivery performed under spinal anaesthesia? A systematic review and meta-analysis. Br J Anaesth. 2012 Nov 1;109(5):679-87.
  Daniel Jolley
summary
3
POISE showed that for every 1000 patients receiving metoprolol, 15 were prevented from suffering a myocardial infract, 3 from requiring cardiac revascularization along with 7 new cases of atrial fibrillation, but at a cost of causing an excess 8 deaths, 5 strokes, 53 hypotensive events and 42 episodes of bradycardia.
The harm associated with perioperative beta-blockade, at least in the form of non-titrated extended-release metoprolol, is greater than the demonstrated benefit. For every two cases of myocardial infract avoided there is one excess death.
POISE Study Group, Devereaux PJ, Yang H et al. Effects of extended-release metoprolol succinate in patients undergoing non-cardiac surgery (POISE trial): a randomised controlled trial. Lancet. 2008 May 31;371(9627):1839-47.
  Daniel Jolley
pearl
1
Perioperative metoprolol in at-risk patients undergoing non-cardiac surgery reduced major cardiovascular adverse events but increased mortality.
POISE Study Group, Devereaux PJ, Yang H et al. Effects of extended-release metoprolol succinate in patients undergoing non-cardiac surgery (POISE trial): a randomised controlled trial. Lancet. 2008 May 31;371(9627):1839-47.
  Daniel Jolley
pearl
1
Multiple labour epidural top-up boluses, caesarean section urgency or care by non-obstetric anaesthetists increase risk of failed epi anaesthesia.
Bauer ME, Kountanis JA, Tsen LC et al. Risk factors for failed conversion of labor epidural analgesia to cesarean delivery anesthesia: a systematic review and meta-analysis of observational trials. Int J Obstet Anesth. 2012 Oct 1;21(4):294-309.
  Daniel Jolley
summary
1
Retrospective studies show that a single anesthesia exposure before age 3 may undermine language acquisition and abstract reasoning, and exposure to two or more anesthetics before age 2 almost doubles the risk of attention-deficit hyperactivity disorder, although in both cases causality has not yet been established.
Olsen EA Brambrink AM. Anesthesia for the young child undergoing ambulatory procedures: current concerns regarding harm to the developing brain. Curr Opin Anaesthesiol. 2013 Dec 1;26(6):677-84.
  Daniel Jolley
pearl
1
Anesthesia neurotoxicity may affect the developing human brain, however methodological challenges limit the conclusiveness of current evidence.
Olsen EA Brambrink AM. Anesthesia for the young child undergoing ambulatory procedures: current concerns regarding harm to the developing brain. Curr Opin Anaesthesiol. 2013 Dec 1;26(6):677-84.
  Daniel Jolley
summary
0
Nerve block duration may be extended by adrenaline, clonidine, dexmedetomidine, dexamethasone, and possibly midazolam, tramadol and magnesium. Other than adrenaline there is however no longterm data demonstrating safety. Intra-articular adjuvant benefit has been shown for tramadol, magnesium, dexmedetomidine, clonidine, ketamine, ketorolac and morphine, but the evidence is not strong enough to support routine use.
Barreveld A, Witte J, Chahal H et al. Preventive analgesia by local anesthetics: the reduction of postoperative pain by peripheral nerve blocks and intravenous drugs. Anesth. Analg. 2013 May 1;116(5):1141-61.
  Daniel Jolley